scholarly journals P737 Left ventricular hemodynamic forces: towards establishing reference values for healthy adults

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F Capuano ◽  
R Cocchia ◽  
F Ferrara ◽  
S Lanero ◽  
V Russo ◽  
...  
Keyword(s):  
Reference Values ◽  
Healthy Subjects ◽  
Left Ventricular ◽  
Healthy Adults ◽  
Disease Assessment ◽  
Lv Function ◽  
Specific Reference ◽  
Endocardial Contour ◽  
Hemodynamic Forces ◽  
Lv Volume

Abstract Introduction Left ventricular hemodynamic forces (LV-HDF) have been recently demonstrated to be promising markers of sub-clinical dysfunction and potential predictors of disease outcome. However, there is a lack of reference values in healthy subjects. Knowledge of physiologic ranges is mandatory towards the use of LV-HDF-based indices for disease assessment in future clinical applications. Purpose Aim of the current study is to define the normal reference values for LV-HDF parameters in a large cohort of healthy adults. Here we present preliminary results for the initial set of enrolled subjects. Methods We enrolled 82 healthy subjects [mean age 44 ± 13.2 years (range 18-88), 41 men]. All participants underwent standard transthoracic echocardiography (TTE) examination, as recommended by current guidelines, including apical two-, three- and four-chamber windows, acquired at a frame rate above 40 Hz. These were then analyzed by tri-plane tissue tracking, measuring LV volume and LV ejection fraction (EF) as reference parameters. The same tracking method was used to evaluate the global hemodynamic force by a novel mathematical calculation technique applied to the three-dimensional endocardial contour. Physical-based LV-HDF parameters were then extracted for clinical application; these included the amplitude (root mean square) of the longitudinal and transversal force components (FL and FT) and their alignment angle relative to the LV axis. Parameters were computed as average over the whole cardiac cycle as well as limited to the systolic phase. Forces were normalized with LV volume to reduce variability with LV dimension, and divided by specific weight to yield a dimensionless measure. Results Mean EF was 63 ± 9%. Whole cycle LV-HDF parameters were: FL = 16.0 ± 5.6%, FT = 2.3 ± 0.8%, with significant longitudinal alignment FT/FL = 0.15 ± 0.04, angle = 13.0°±3.1°. Systolic HDF parameters were: FL = 22.7 ± 8.2%, FT = 2.9 ± 1.1%, with longitudinal alignment FT/FL = 0.13 ± 0.04, angle = 11.2°±3.1°. Importantly, dimensionless physical-based LV-HDF parameters showed no significant variation with age, gender or BSA. Conclusions We report the physiologic range of LV-HDF parameters measured by TTE. Knowledge of age- and gender-specific reference values, for a combination of standard, mechanical and hemodynamic indices, can improve the global assessment of the LV function and may help to detect sub-clinical stages of LV dysfunction.

scholarly journals Reference Ranges of Left Ventricular Hemodynamic Forces in Healthy Adults: A Speckle-Tracking Echocardiographic Study

2021 ◽  
Vol 10 (24) ◽  
pp. 5937
Author(s):  
Francesco Ferrara ◽  
Francesco Capuano ◽  
Rosangela Cocchia ◽  
Brigida Ranieri ◽  
Carla Contaldi ◽  
...  
Keyword(s):  
Healthy Subjects ◽  
Multivariable Analysis ◽  
Specific Weight ◽  
Left Ventricular ◽  
Lv Function ◽  
Reference Ranges ◽  
Full Spectrum ◽  
Hemodynamic Forces ◽  
Normal Limits ◽  
Echo Doppler Examination

Background: The normal limits of left ventricular (LV) hemodynamic forces (HDFs) are not exactly known. The aim of this study was to explore the full spectrum of HDF parameters in healthy subjects and determine their physiologic correlates. Methods: 269 healthy subjects were enrolled (mean age: 43 ± 14 years; 123 (45.7%) men). All participants underwent an echo-Doppler examination. Tri-plane tissue tracking from apical views was used to measure 2D global endocardial longitudinal strain (GLS), circumferential strain (GCS), and LV HDFs. HDFs were normalized with LV volume and divided by specific weight. Results: LV systolic longitudinal HDFs (%) were higher in men (20.8 ± 6.5 vs. 18.9 ± 5.6, p = 0.009; 22.0 ± 6.7 vs. 19.8 ± 5.6, p = 0.004, respectively). There was a significant correlation between GCS (increased) (r = −0.240, p < 0.001) and LV longitudinal HDFs (reduced) (r = −0.155, p = 0.01) with age. In a multivariable analysis age, BSA, pulse pressure, heart rate and GCS were the only independent variables associated with LV HDFs (β coefficient = −0.232, p < 0.001; 0.149, p = 0.003; 0.186, p < 0.001; 0.396, p < 0.001; −0.328, p < 0.001; respectively). Conclusion: We report on the physiologic range of LV HDFs. Knowledge of reference values of HDFs may prompt their implementation into clinical routine and allow a more comprehensive assessment of the LV function.

scholarly journals Association between Native Myocardial T1 Mapping and Cardiac Function and Macroscopic Fibrosis in Thalassemia Major

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 26-27
Author(s):  
Alessia Pepe ◽  
Nicola Martini ◽  
Antonio De Luca ◽  
Vincenzo Positano ◽  
Laura Pistoia ◽  
...  
Keyword(s):  
Iron Overload ◽  
Myocardial Fibrosis ◽  
T1 Mapping ◽  
Thalassemia Major ◽  
Left Ventricular ◽  
Lv Function ◽  
Myocardial Iron ◽  
Native T1 ◽  
Molli Sequence ◽  
Lv Volume

Background.Cardiovascular magnetic resonance (CMR) is the only available technique for the non-invasive quantification of MIO. The native T1 mapping has recently been proposed as an alternative to the universally adopted T2* technique, due to the higher sensitivity for detection of changes associated with mild or early iron overload. Objective.To study the association between T1 values and left ventricular (LV) function in thalassemia major (TM) and to evaluate for the first time if T1 measurements quantifying MIO are influenced by macroscopic myocardial fibrosis. Methods.146 TM patients (87 females, 38.7±11.1 years) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network underwent CMR. Native T1 values were obtained by Modified Look-Locker Inversion recovery (MOLLI) sequence in all 16 myocardial segments and the global value was the mean. LV function parameters were quantified by cine images. Late gadolinium enhancement (LGE) technique was used to detect macroscopic myocardial fibrosis. Results.No correlation was detected between global heart T1 values and LV volume indexes, LV mass index, or LV ejection fraction. Foourteen (9.6%) patients had an abnormal LV motion (13 hypokinesia and 1 dyskinesia) and they showed significantly lower global heart T1 values than patients without LV motion abnormalities (883.8±139.7 ms vs 959.0±91.3 ms; P=0.049). LGE images were acquired in 88 patients (60.3%) and macroscopic myocardial fibrosis was detected in 36 patients (40.9%). The 72.2% of patients had two or more foci of fibrosis. Patients with macroscopic myocardial fibrosis had significantly lower global heart T1 values (921.3±100.3 ms vs 974.5±72.7 ms; P=0.027) (Figure 1A). Data about the LGE was present for 1408 segments (88 patients x 16 segments) and 105 (7.5%) were positive. Segments with LGE had significantly lower T1 values than segments LGE-negative (905.6±110.6 ms vs 956.9±103.8 ms; P&lt;0.0001) (Figure 1B). Conclusion.No correlation between T1 values and LV function parameters was detected, probably because the majority of the patients had normal or mild abnormal LV parameters. TM patients with macroscopic myocardial fibrosis showed significantly lower T1 values suggesting that T1 measurements for quantifying MIO are not influenced by macroscopic myocardial fibrosis and an association between myocardial iron and macroscopic fibrosis, previously detected only in pediatric TM patients. Figure Disclosures Pepe: Chiesi Farmaceutici S.p.A.:Other: no profit support and speakers' honoraria;Bayer:Other: no profit support;ApoPharma Inc.:Other: no profit support.Pistoia:Chiesi Farmaceutici S.p.A.:Other: speakers' honoraria.Meloni:Chiesi Farmaceutici S.p.A.:Other: speakers' honoraria.

Reversible effects of isoproterenol-induced hypertrophy on in situ left ventricular function in rat hearts

2004 ◽  
Vol 287 (1) ◽  
pp. H277-H285 ◽  
Author(s):  
Yutaka Kitagawa ◽  
Daisuke Yamashita ◽  
Haruo Ito ◽  
Miyako Takaki
Keyword(s):  
Cardiac Hypertrophy ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Lv Function ◽  
Osmotic Minipump ◽  
Good Index ◽  
Rat Hearts ◽  
Lv Volume ◽  
Work Capability

The aim of the present study was to evaluate specifically left ventricular (LV) function in rat hearts as they transition from the normal to hypertrophic state and back to normal. Either isoproterenol (1.2 and 2.4 mg·kg−1·day−1 for 3 days; Iso group) or vehicle (saline 24 μl·day−1 for 3 days; Sa group) was infused by subcutaneous implantation of an osmotic minipump. After verifying the development of cardiac hypertrophy, we recorded continuous LV pressure-volume (P-V) loops of in situ ejecting hypertrophied rat hearts. The curved LV end-systolic P-V relation (ESPVR) and systolic P-V area (PVA) were obtained from a series of LV P-V loops in the Sa and Iso groups 1 h or 2 days after the removal of the osmotic minipump. PVA at midrange LV volume (PVAmLVV) was taken as a good index for LV work capability ( 13 , 15 , 20 , 21 ). However, in rat hearts during remodeling, whether PVAmLVV is a good index for LV work capability has not been determined yet. In the present study, in contrast to unchanged end-systolic pressure at midrange LV volume, PVAmLVV was significantly decreased by isoproterenol treatment relative to saline; however, these measurements were the same 2 days after pump removal. Simultaneous treatment with a β1-blocker, metoprolol (24 mg·kg−1·day−1), blocked the formation of cardiac hypertrophy and thus PVAmLVV did not decrease. The reversible changes in PVAmLVV reflect precisely the changes in LV work capability in isoproterenol-induced hypertrophied rat hearts mediated by β1-receptors. These results indicate that the present approach may be an appropriate strategy for evaluating the effects of antihypertrophic and antifibrotic modalities.

Nonuniformity and volume loading independently influence isovolumic relaxation rates

1989 ◽  
Vol 257 (6) ◽  
pp. H1927-H1935 ◽  
Author(s):  
T. C. Gillebert ◽  
W. Y. Lew
Keyword(s):  
Anterior Wall ◽  
Left Ventricular ◽  
Lv Function ◽  
Loading Conditions ◽  
Relaxation Rates ◽  
Volume Loading ◽  
Two Factors ◽  
Lv Volume ◽  
Pressure Fall ◽  
Isovolumic Relaxation

We examined the influence of loading conditions and nonuniformity of left ventricular (LV) function on the rate of LV pressure fall in seven anesthetized dogs. Loading conditions were altered with vena cavae occlusions and/or intravenous infusions of dextran. Nonuniformity was produced by injecting 8-20 ng of isoproterenol into the mild left anterior descending coronary artery to produce an asynchronous and early onset of segment lengthening in the anterior wall. Temporal and regional nonuniformity were quantified with indexes derived by comparing segment lengths in the anterior and posterior walls, measured with midwall sonomicrometers. The rate of LV pressure fall was assessed with peak -dP/dt, the time constant, tau, and the duration of isovolumic relaxation. Volume loading decreased the rate of LV pressure fall without altering the nonuniformity indexes. Intracoronary isoproterenol produced nonuniformity and decreased the rate of LV pressure fall without altering global loading conditions. The effects of isoproterenol (in a constant dose) were similar irrespective of the LV volume. We conclude that in the intact, ejecting left ventricle, loading conditions and nonuniformity are important determinants of the rate of LV pressure fall, but these two factors exert their influence by mechanisms that are largely independent.

Atrioventricular plane displacement is the major contributor to left ventricular pumping in healthy adults, athletes, and patients with dilated cardiomyopathy

2007 ◽  
Vol 292 (3) ◽  
pp. H1452-H1459 ◽  
Author(s):  
Marcus Carlsson ◽  
Martin Ugander ◽  
Henrik Mosén ◽  
Torsten Buhre ◽  
Hakan Arheden
Keyword(s):  
Dilated Cardiomyopathy ◽  
Healthy Subjects ◽  
Radial Function ◽  
Left Ventricular ◽  
Lv Function ◽  
Short Axis ◽  
Resonance Imaging ◽  
Atrioventricular Plane Displacement ◽  
The Mean ◽  
Plane Displacement

Previous studies using echocardiography in healthy subjects have reported conflicting data regarding the percentage of the stroke volume (SV) of the left ventricle (LV) resulting from longitudinal and radial function, respectively. Therefore, the aim was to quantify the percentage of SV explained by longitudinal atrioventricular plane displacement (AVPD) in controls, athletes, and patients with decreased LV function due to dilated cardiomyopathy (DCM). Twelve healthy subjects, 12 elite triathletes, and 12 patients with DCM and ejection fraction below 30% were examined by cine magnetic resonance imaging. AVPD and SV were measured in long- and short-axis images, respectively. The percentage of the SV explained by longitudinal function (SVAVPD%) was calculated as the mean epicardial area of the largest short-axis slices in end diastole multiplied by the AVPD and divided by the SV. SV was higher in athletes [140 ± 4 ml (mean ± SE), P = 0.009] and lower in patients (72 ± 7 ml, P < 0.001) when compared with controls (116 ± 6 ml). AVPD was similar in athletes (17 ± 1 mm, P = 0.45) and lower in patients (7 ± 1 mm, P < 0.001) when compared with controls (16 ± 0 mm). SVAVPD%was similar both in athletes (57 ± 2%, P = 0.51) and in patients (67 ± 4%, P = 0.24) when compared with controls (60 ± 2%). In conclusion, longitudinal AVPD is the primary contributor to LV pumping and accounts for ∼60% of the SV. Although AVPD is less than half in patients with DCM when compared with controls and athletes, the contribution of AVPD to LV function is maintained, which can be explained by the larger short-axis area in DCM.

Normal reference values of three-dimensional speckle-tracking echocardiography-derived left ventricular strain parameters in healthy adults

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Nemes ◽  
A Kormanyos ◽  
A Kalapos ◽  
P Domsik ◽  
N Gyenes ◽  
...  
Keyword(s):  
Reference Values ◽  
Healthy Subjects ◽  
Speckle Tracking ◽  
Healthy Adult ◽  
Speckle Tracking Echocardiography ◽  
Three Dimensional ◽  
Left Ventricular ◽  
Valvular Regurgitation ◽  
Success Ratio ◽  
Normal Reference

Abstract Introduction At this moment, limited number of studies is defining normal reference value of three-dimensional (3D) speckle-tracking echocardiography (3DSTE)-derived left ventricular (LV) strains. The present study aimed to quantify normal reference values of LV strains in healthy adult population in real clinical world settings in different age groups and to determine age- and gender-dependence of these parameters in a high volume single centre. Methods The present study comprised 296 healthy adult subjects from which 124 cases were excluded due to inferior image quality during a 6-year period. The remaining population was further divided into 4 subgroups based on age decades. The following groups of healthy subjects were examined based on their age: 18–29 years (mean age: 23.6±2.8 years, 45 males out of 94), 30–39 years (mean age: 33.7±2.8 years, 27 males out of 34), 40–49 years (mean age: 43.4±3.4 years, 11 males out of 17) and 50+ years (mean age: 56.4±5.3 years, 12 males out of 27). All subjects underwent a complete 2D echocardiographic and Doppler assessment with negative results. None of the healthy subjects showed more than grade 1 valvular regurgitation or significant stenosis on any valves. Results The mean LV radial (RS), circumferential (CS), longitudinal (LS), 3D (3DS) and area (AS) strains proved to be 27.7±8.8%, −28.6±4.8%, −16.9±2.4%, 30.2±8.8% and −41.4±4.9%, respectively. While global LV-RS and LV-3DS showed an increase-decrease-increase pattern, LV-CS, LV-LS and LV-AS were somewhat lower in older ages. Only global LV-LS showed gender-dependency with higher values in females. Although somewhat higher LV-RS and LV-3DS and lower LV-CS, LV-LS and LV-AS could be measured in males, clear gender-dependency could not be detected in different age decades. The measurements were performed between 2011 and 2017, when feasibility of 3DSTE analysis improved as the operators gained experience. The number of adequate measurements proved to be 172 out of 296 (58% success ratio) for the overall time-period. For the last year, the number of good quality measurements, therefore the success ratio improved significantly (47 out of 59, 80%, p=0.001). Conclusions Normal reference values of 3DSTE-derived global, segmental, mean segmental and regional LV strains have been determined in healthy adult subjects based on real-life clinical experience. Age-, gender- and functional non-uniformity of LV strains were also defined. Funding Acknowledgement Type of funding source: None

Serum thyroglobulin reference values according to NACB criteria in healthy subjects with normal thyroid ultrasound

2012 ◽  
Vol 50 (5) ◽  
Author(s):  
Luca Giovanella ◽  
Mauro Imperiali ◽  
Anna Ferrari ◽  
Alessia Palumbo ◽  
Lino Furlani ◽  
...  
Keyword(s):  
Reference Values ◽  
Healthy Subjects ◽  
Reference Interval ◽  
Reference Population ◽  
Specific Reference ◽  
Logarithmic Scale ◽  
Reference Ranges ◽  
Thyroid Ultrasound ◽  
Serum Thyroglobulin ◽  
Automated Platform

AbstractThe present study was undertaken to establish serum thyroglobulin (Tg) normal reference values in a large group of healthy subjects.Four hundred and thirty-eight non-smoking healthy subjects were selected to assess the Tg reference values (209 males, 229 non-pregnant females, age 34.7±13.1 years). Inclusion criteria were: no personal or familial history of thyroid disease, thyrotropin levels from 0.5 to 2.00 mUI/L, negative thyroperoxidase and thyroglobulin antibodies. In addition, the patients had a normal size thyroid (females ≤18 mL, males ≤25 mL) without nodules on the thyroid ultrasound (TUS). According to National Academy of Clinical Biochemistry (NACB) criteria the Tg results were transformed to a logarithmic scale and reference ranges were calculated as mean±2 SD.Serum Tg was measured on the Beckman Coulter UniCel DxI 800 automated platform by the simultaneous 1-step immunoenzymatic Access Thyroglobulin assay (Beckmann-Coulter SA, Nyon, Switzerland). Serum Tg levels were higher in females than in males (p=0.0022). Accordingly, gender-specific reference values were calculated (i.e., males: 1.40–29.2 ng/mL; females: 1.50–38.5 ng/mL).To the best of the authors’ knowledge, the first reference interval study for Tg that integrates NACB criteria and TUS assessment for the selection of the reference population is provided here.

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